Endometriosis symptoms vary from person to person and may worsen over time. It can be easy to mistake endometriosis for other conditions with similar symptoms, including ovarian cysts, pelvic inflammatory disease, and inflammatory bowel disease.

The causes of endometriosis aren’t always clear, but knowing the symptoms can help you manage endometriosis effectively. Read on to learn more about the signs and symptoms of endometriosis.

1. Chronic Pelvic Pain

The main symptom of endometriosis is severe pelvic pain. Where and how the pain occurs depends on where the disease is active in your body. Endometriosis involves endometrial tissue growing where it shouldn’t, such as the ovaries, fallopian tubes, and on or around other reproductive organs. You may develop pain anywhere the abnormal endometrial tissue grows.

You may especially notice the pain during your period. Some people feel pain more often or even constantly, even at times unrelated to menstruation.

2. Painful Periods

People with endometriosis describe painful periods that include pelvic pain and cramping that starts before a period and lasts several days. This pain may be felt in the lower back or the abdomen.

Cramps are often associated with menstruation, but people with endometriosis typically describe period pain that’s far more intense than normal. Dysmenorrhea (painful periods) may cause your period cramps to be so bad you can’t move.

Is Endometriosis Period Pain Different From Period Pain?

Generally, period cramps and pain can be managed with over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin). However, the pain from endometriosis-related cramping is often much more intense. Many people with endometriosis experience severe cramping that disrupts their daily activities, including work. People who’ve experienced this pain have described it as stabbing, aggressive, and distressing.

In some cases, stronger medication may be needed to manage symptoms. Prescription medications, including narcotic pain relievers, may sometimes help control breakthrough pain that’s not managed by NSAIDs alone​​​​​.

3. Pain During Sex

People with endometriosis often experience pain during or after sexual intercourse due to nodules (hard lumps) that form in the pelvic cavity. During sex, these nodules get pushed or moved around, causing deep pain.

The pain can also lead people to avoid or reduce sexual activity, which can affect romantic relationships and overall well-being.

4. Irregular Periods

Another symptom of endometriosis, irregular periods, can make it difficult to track and predict cycles. Periods may be considered irregular if they last more than seven days, occur fewer than 21 days apart, or happen more than 35 days apart. Your periods may also be irregular if the length of your cycle varies.

5. Problems With Urination and Bowel Movements

Pain that comes with bowel movements or urination may indicate that endometriosis is affecting the intestines or bladder, especially if this symptom seems related to your menstrual cycle.

Endometriosis that involves the bladder can cause frequent urges to urinate. You might experience symptoms similar to those of a urinary tract infection, including:

• A burning feeling when urinating
• Blood in urine
• Pain when your bladder is full

When endometriosis affects the intestines or bowels, it can cause gastrointestinal problems such as diarrhea, constipation, bloating, or nausea. You might mistake these symptoms for irritable bowel syndrome. However, bowel symptoms associated with endometriosis tend to occur during menstrual periods.

6. Fatigue

It’s estimated that 50 percent of people with endometriosis experience fatigue. This symptom isn’t the same as feeling tired after a long week or a sleepless night. Fatigue related to endometriosis may be so severe that you can’t stay awake or be productive. Sometimes, fatigue is a precursor to a painful endometriosis flare-up.

Fatigue from endometriosis often occurs because the body’s immune system responds to endometriosis lesions as if they were harmful. This immune response releases inflammatory chemicals that contribute to persistent tiredness and a drained feeling.

Chronic fatigue can also be linked to anemia, which may develop from heavy or prolonged bleeding that may sometimes be associated with endometriosis​​​​. Fatigue from endometriosis has also been linked with depression, pain, insomnia, and stress.

7. Fertility Issues

Endometriosis is often diagnosed in people seeking infertility treatment. About 24 percent to 50 percent of women who experience infertility have endometriosis, according to Johns Hopkins Medicine.

Additionally, up to 50 percent of people with endometriosis experience trouble getting pregnant. Those who do become pregnant might have problems during pregnancy. Moderate to severe endometriosis raises the risk of pregnancy complications such as miscarriage, early delivery, cesarean section, and ruptured blood vessels.

Endometriosis doesn’t directly cause fertility issues but may lead to infertility for a few reasons:

• Scar tissue may block parts of the reproductive tract, making it difficult for the egg and sperm to meet.
• Scarring around the ovaries can interfere with the release of an egg.
• Inflammation may damage the egg, sperm, or embryo before implantation can occur.

If you have endometriosis and want to get pregnant, talk with your doctor. They can tell you about treatment options such as surgery or in vitro fertilization that may help you get pregnant if you experience fertility issues.

8. A Lack of Symptoms

Some people with endometriosis may be asymptomatic — they don’t experience any symptoms. They may find out they have the condition if they’re trying to get pregnant or after having an unrelated surgery.

What Age Do Signs of Endometriosis Appear?

Most people with endometriosis begin to show symptoms a few years after they start menstruating, but symptoms sometimes start as early as a person’s first period, often in the teen years. However, it can take years to receive an accurate diagnosis, with most people being diagnosed in their 20s or 30s. A surgical procedure called laparoscopy is considered the gold standard for diagnosing endometriosis.

Do Endometriosis Symptoms Go Away?

For many people, endometriosis symptoms ease after menopause. However, if estrogen therapy is used to manage menopause symptoms, endometriosis issues may continue. Symptoms may also improve during pregnancy, but they often return after giving birth.

Although there’s no cure for this condition, treatments for endometriosis can help reduce symptoms and slow disease progression.

Talk With Others Who Understand

MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 136,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

What endometriosis symptoms do you experience? Do you have symptoms that aren’t on this list? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.